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Approximately 20% of older persons with dementia have atrial fibrillation (AF). Nearly all have stroke risks that exceed the guideline-recommended threshold for anticoagulation. Although individuals with dementia develop profound impairments and die from the disease, little evidence exists to guide anticoagulant discontinuation, and almost one-third of nursing home residents with advanced dementia and AF remain anticoagulated in the last 6 months of life. We aimed to quantify the benefits and harms of anticoagulation in this population.Using Minimum Data Set and Medicare claims, we conducted a retrospective cohort study with 14,877 long-stay nursing home residents aged ≥66 between 2013 and 2018 who had advanced dementia and AF. We excluded individuals with venous thromboembolism and valvular heart disease. We measured anticoagulant exposure quarterly, using Medicare Part D claims. The primary outcome was all-cause mortality; secondary outcomes were ischemic stroke and serious bleeding. We performed survival analyses with multivariable adjustment and inverse probability of treatment (IPT) weighting.In the study sample, 72.0% were female, 82.7% were aged ≥80 years, and 13.5% were nonwhite. Mean CHAPersons with advanced dementia and AF derive clinically modest life prolongation from anticoagulation, at the cost of elevated risk of bleeding. The relevance of this benefit is unclear in a group with high dementia-related mortality and for whom the primary goal is often comfort.

Representation of the optimization process to automate the development of mortar mixes for robotic 3D printing with the aim to reduce the required workload while generating mixture compositions with improved properties by following an optimum trend.

This article presents a proof-of-concept to recycle microbrewery waste as a carbon source for synthesizing carbon dots (CDs). A simple method has been developed to synthesize water-soluble CDs based on microwave irradiation of brewery spent grain. The structures and optical properties of the CDs were characterized by ultraviolet-visible (UV-Vis) spectroscopy, photoluminescence spectroscopy (PL), X-ray photoelectron spectroscopy (XPS) and transmission electron microscopy. The effects of reaction time, temperature and pH on the properties of carbon dots were studied. These CDs were found to be spherical with an average diameter of 5.3 nm, N-doped, containing many functional groups (hydroxyl, ethers, esters, carboxyl and amino groups), and to exhibit good photoluminescence with a fluorescent quantum yield of 14%. Finally, the interaction between carbon dots and metal ions was investigated towards developing CDs as a sensing technology for water treatment, food quality and safety detection.

Tailings dams retain the waste by-products of mining operations and are among the world’s largest engineered structures. Recent tailings dam failures highlight important gaps in current monitoring methods. Here we demonstrate how ambient noise interferometry can be applied to monitor dam performance at an active tailings dam using a geophone array. Seismic velocity changes of less than 1% correlate strongly with water level changes at the adjacent tailings pond. We implement a power-law relationship between effective stress and shear wave velocity, using the pond level recordings with shear wave velocity profiles obtained from cone penetration tests to model changes in shear wave velocities. The resulting one-dimensional model shows good agreement with the seismic velocity changes. As shear wave velocity provides a direct measure of soil stiffness and can be used to infer numerous other geotechnical design parameters, this method provides important advances in understanding changes in dam performance over time.

Contemporary patients with heart failure with reduced ejection fraction (HFrEF) are older and have a higher prevalence of cognitive impairment than those studied in trials. The risk/benefit trade-off of routine beta-blocker (BB) use in patients with HFrEF and Alzheimer's disease and related dementias (ADRD) has not been explored. This study aimed to determine the association between BB use and outcomes among patients with HFrEF and ADRD.Using a random 40% sample of Medicare Parts A, B, and D data we identified patients with ≥1 hospitalization for HFrEF between 2008 and 2018. Each patient was classified based on BB use prior to admission and after discharge. Outcomes include 90-day and 1-year mortality and readmission.Between 2008 and 2018, we identified 357,030 patients hospitalized with HFrEF; 12.7% had ADRD. Patients with HFrEF and ADRD had higher 90-day and 1-year mortality compared to patients with HFrEF-only. Among patients admitted on a BB, 60.5% of patients with HFrEF-only were continued on therapy after discharge, compared to 56.8% of patients with HFrEF and ADRD. Discontinuing BB was associated with a 2.2-fold higher risk of 90-day mortality (p 0.001) among patients with HF-only and a 2.- fold higher risk of 90-day mortality (p 0.001) among patients with HFrEF + ADRD. Not starting a BB was associated with a 1.8-fold higher risk of 90-day mortality (p 0.001) among patients with HFrEF-only and a 1.7-fold higher risk of 90-day mortality (p 0.001) among patients with HFrEF + ADRD. Similar risks were seen at 1 year.BB therapy is associated with significantly lower short and long-term mortality rates among all patients with HFrEF; the magnitude of these associated benefits appear at least as large in patients with HFrEF and ADRD compared to patients with HFrEF-only.

With the recent progress in nanotechnology and material engineering, nano-based coatings have become multifunctional, smarter, efficient, versatile and durable. Superhydrophobic coatings are an important class of the smart coating family, which has gained recognition in coating science over the last few years. The uniqueness of superhydrophobic coatings arises from the various phenomenal innovations, and its development is expected to continue in the next decades. The bioinspired superhydrophobic surfaces are commonly obtained by designing a double-scale structure by using nanotechnology, followed by the addition of water repellent compounds. It lacks an overview article describing on the recent progress in superhydrophobic coatings and surfaces. In this perspective article, various fundamental aspects of wettability and related phenomena are discussed. We present and compare the existing methods for the preparation of superhydrophobic coatings. Properties of superhydrophobic coatings such as self-cleaning, anti-icing, anti-fouling, and anti-bacterial features were also introduced. The review also discusses various superhydrophobic technological breakthroughs and future trends in the preparation and application of these materials.

ObjectiveTo develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains.MethodsWe used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a prospective cohort study that enrolled participants aged ≥75 years with AMI from 94 US hospitals. Participants underwent an in-hospital assessment of functional impairments, including cognition, vision, hearing and mobility. Clinical variables previously shown to be associated with readmission risk were also evaluated. The outcome was 180-day readmission. From an initial list of 72 variables, we used backward selection and Bayesian model averaging to derive a risk model (N=2004) that was subsequently internally validated (N=1002).ResultsOf the 3006 SILVER-AMI participants discharged alive, mean age was 81.5 years, 44.4% were women and 10.5% were non-white. Within 180 days, 1222 participants (40.7%) were readmitted. The final risk model included 10 variables: history of chronic obstructive pulmonary disease, history of heart failure, initial heart rate, first diastolic blood pressure, ischaemic ECG changes, initial haemoglobin, ejection fraction, length of stay, self-reported health status and functional mobility. Model discrimination was moderate (0.68 derivation cohort, 0.65 validation cohort), with good calibration. The predicted readmission rate (derivation cohort) was 23.0% in the lowest quintile and 65.4% in the highest quintile.ConclusionsOver 40% of participants in our sample experienced hospital readmission within 180 days of AMI. Our final readmission risk model included a broad range of characteristics, including functional mobility and self-reported health status, neither of which have been previously considered in 180-day risk models.

While survival after acute myocardial infarction has improved substantially, older adults remain at heightened risk for hospital readmissions and death. Evidence for the role of cognitive impairment in older myocardial infarction survivors' risk for these outcomes is limited.3041 patients aged ≥75 years hospitalized with acute myocardial infarction (mean age 82 ± 5 years, 56% male) recruited from 94 US hospitals. Cognition was assessed using the Telephone Interview for Cognitive Status; scores of27 and22 indicated mild and moderate/severe impairment, respectively. Readmissions and death at 6 months post-discharge were ascertained via participant report and medical record review. Associations between cognition and outcomes were evaluated with multivariable-adjusted logistic regression.Mild and moderate/severe cognitive impairment were present in 11% and 6% of the cohort, respectively. Readmission and death at 6 months occurred in 41% and 9% of participants, respectively. Mild and moderate/severe cognitive impairment were associated with increased risk of readmission (odds ratio [OR] 1.36; 95% confidence interval [CI], 1.08-1.72 and OR 1.58; 95% CI, 1.18-2.12, respectively) and death (OR 2.19; 95% CI, 1.54-3.11 and OR 3.82; 95% CI, 2.63-5.56, respectively) in unadjusted analyses. Significant associations between moderate/severe cognitive impairment and death (OR 1.69; 95% CI, 1.10-2.59) persisted after adjustment for demographics, myocardial infarction characteristics, comorbidity burden, functional status, and depression, but not for readmissions.Moderate-to-severe cognitive impairment is associated with heightened risk of death in older acute myocardial infarction patients in the months after hospitalization, but not with readmission. Routine cognitive screening may identify older myocardial infarction survivors at risk for poor outcomes who may benefit from closer oversight and support in the post-discharge period.

Australia's and China's resources (e.g. Olympic Dam Cu-U-Au-Ag and Bayan Obo REE deposits) highlight how discovery and mining of iron oxide copper-gold (IOCG), iron oxide±apatite (IOA) and affiliated primary critical metal deposits in metasomatic iron and alkali-calcic (MIAC) mineral systems can secure a long-term supply of critical metals for Canada and its partners. In Canada, MIAC systems comprise a wide range of undeveloped primary critical metal deposits (e.g. NWT NICO Au-Co-Bi-Cu and Québec HREE-rich Josette deposits). Underexplored settings are parts of metallogenic belts that extend into Australia and the USA. Some settings, such as the Camsell River district explored by the Dene First Nations in the NWT, have infrastructures and 100s of km of historic drill cores. Yet vocabularies for mapping MIAC systems are scanty. Ability to identify metasomatic vectors to ore is fledging. Deposit models based on host rock types, structural controls or metal associations underpin the identification of MIAC-affinities, assessment of systems' full mineral potential and development of robust mineral exploration strategies. This workshop presentation reviews public geoscience research and tools developed by the Targeted Geoscience Initiative to establish the MIAC frameworks of prospective Canadian settings and global mining districts and help de-risk exploration for IOCG, IOA and affiliated primary critical metal deposits. The knowledge also supports fundamental research, environmental baseline assessment and societal decisions. It fulfills objectives of the Canadian Mineral and Metal Plan and the Critical Mineral Mapping Initiative among others. The GSC-led MIAC research team comprises members of the academic, private and public sectors from Canada, Australia, Europe, USA, China and Dene First Nations. The team's novel alteration mapping protocols, geological, mineralogical, geochemical and geophysical framework tools, and holistic mineral systems and petrophysics models mitigate and solve some of the exploration and geosciences challenges posed by the intricacies of MIAC systems. The group pioneers the use of discriminant alteration diagrams and barcodes, the assembly of a vocab for mapping and core logging, and the provision of field short courses, atlas, photo collections and system-scale field, geochemical, rock physical properties and geophysical datasets are in progress to synthesize shared signatures of Canadian settings and global MIAC mining districts. Research on a metamorphosed MIAC system and metamorphic phase equilibria modelling of alteration facies will provide a foundation for framework mapping and exploration of high-grade metamorphic terranes where surface and near surface resources are still to be discovered and mined as are those of non-metamorphosed MIAC systems.

Background In Burkina Faso, maternity is a risk. Global Affairs Canada funded the initiative PASME-2 with World University Service of Canada, Laval University and Farm Radio International to improve maternal outcomes. A preventative program was co-developed in phases. Phase 3 received funding from Social Sciences and Humanities Research Council in partnership with the Centre for International Cooperation in Health and Development (CCISD) and TIESS, a liaison and transfer expert in Québec, to support local teams towards sustainable practice changes. This research aimed at documenting the partnership experience, digital literacy, perceived direct and indirect outcomes. Methods A participative co-design approach, allowed the engagement of several stakeholders in the process. Two active phases where 16 health professionals engaged actively in the VCoP, according to the final agreed-upon Constitutional Chart, are presented. The phases pilot-tested two different technology tools. Results 16 interviews post-phase 1 and 16 interviews post-phase 2 were conducted. Implementation issues as perceived by users are discussed and include: feasibility, challenges, needs, animation, relevance to care, communication and sharing, use and perspectives. Perceived outcomes focus on professional preventative practice changes, skills, family outcomes, challenges to practice integration, knowledge and practice exchanges. Conclusions The phases of experimentation demonstrate that strategies can be put in place to counter the digital literacy challenges and to engage users in new ways of communicating, sharing on the platform about health practices and taking valuable time to do it. Overcoming technology constraints is essential especially in lower resource settings. The most practical life experiences and cases lead to more engagement and innovations. Support from management and upper directorate is significant. Key messages Partnership from several stakeholders is key to implementing a VCoP. Experimenting and sharing solutions is influenced by the capacitating environment that the VCoP can provide with recognition from administration and as a professional development activity.

Problem From a focus on transmittable diseases, attention to prevention and promotion has become a priority since 2011. Influenced by the Political Declaration of the High-level Meeting on the Prevention and Control of Non-communicable Diseases and The Rio Declaration on Social Determinants of Health, many countries across the world have identified targets aiming at chronic diseases prevention, preventable death and reduced morbidity. Individual behavior changes remain a challenge for health practitioners. Shanghai Declaration suggests that health literacy is a critical determinant for healthy choices and decisions. Description A healthy living program has been developed and offered in partnership between local public health and university Laval. We present the case of the community housing Mimosa du Quartier and its preventative nursing clinic. Eight-week Preventative circles and e-prevention interventions from kinesiologist, nutritionist and nurses are explored. IPads were provided to families and we used REACT technology. Results Discussion on e-health relevance, feasibility and impact is proposed. Program description, personalised action plan using SMART goals, health literacy and prevention gains are revealed. Relevance, feasibility and perceived impact are discussed. Learning about the user's experience, we can improve the telehealth program in support of continuity of care within the homes of families. This strategy is key to self-management and empowerment Lessons. Health promotion with e-prevention is strategic for sustainable family health. Combining strategies can improve outcomes. This pilot research shows promising results and practical considerations are given to the importance of the relational and alliance aspect of the care relationship even through technology use, to digital literacy capabilities, to family's motivation and engagement and finally to the advantages provided by the technology use. Key messages E-health prevention is an innovative avenue to fight chronic disease. Increased engagement in self-management leads to equity and less adverse outcomes for vulnerable families.

Background In Burkina Faso, maternity is a risk. Global Affairs Canada funded the initiative PASME-2 with World University Service of Canada, Laval University and Farm Radio International to improve maternal outcomes. A preventative program was co-developed. Phase 1 included to train the Health Ministry training coordinators. Phase 2 related to the training of nearly 100 health professionals. Phase 3 received funding from Social Sciences and Humanities Research Council in partnership with the Centre for International Cooperation in Health and Development and TIESS, a liaison and transfer expert in Québec, to support local teams towards sustainable practice changes. Results On the first objective, to describe the co-development of this living lab are presented. We share our perspective of the co-designing challenges, tools, and solutions. We will demonstrate the VCoP platform and environment. Method. A participative co-design approach, allowed the engagement of several stakeholders in the process. Results. Four workshops were organised. Seventeen maternal and child care health professionals took part in the initial 8-month development phase. Results Four steps of the six phases of Gusche innovation design are presented with associated products and results. Implementation challenges, critical decisions, role of face-to-face meetings, technology factors, digital literacy and solutions are presented. Conclusions Implementing a technology innovation in low income setting with limited access to the web and to technologies is a challenge. Its advantages are greater: access to evidenced-base care, facilitating professional development, creating a safe space and leading to emerging problem-solving collective solutions. Conceived as a capacitating environment (Sen) and supporting strength-based (Gottlieb) care through partnership, this VCoP becomes a driver of action to maintain preventative health competence and to share experiences and ways of knowing. Key messages The digital space crosses the borders and can contribute to human development and expansion of safe, evidenced-based and culturally appropriate professional practices. Working in partnerships, interprofessional and intersectoral, with public and community groups can create synergies that will unfold in greater health equity.

Highlights • What is the primary question addressed by this study? As a medical student interest group, can we alleviate social isolation suffered by nursing home residents during the COVID-19 pandemic through weekly phone calls? • What is the main finding of this study? The Yale Geriatrics Student Interest Group implemented the Telephone Outreach in the COVID-19 Outbreak Program at three nursing homes with initial success. Nursing home residents report looking forward to their weekly phone calls and gratitude for social connectedness. • What is the meaning of this finding? Social isolation and loneliness in nursing home seniors—a common concern now exacerbated by the COVID-19 pandemic—is partly relieved by our replicable telephone outreach program., Objective Social isolation and loneliness—common concerns in older adults—are exacerbated by the COVID-19 pandemic. To address social isolation in nursing home residents, the Yale School of Medicine Geriatrics Student Interest Group initiated a Telephone Outreach in the COVID-19 Outbreak (TOCO) Program that implements weekly phone calls with student volunteers. Methods Local nursing homes were contacted; recreation directors identified appropriate and interested elderly residents. Student volunteers were paired with elderly residents and provided phone call instructions. Results Three nursing homes opted to participate in the program. Thirty elderly residents were paired with student volunteers. Initial reports from recreation directors and student volunteers were positive: elderly residents look forward to weekly phone calls and express gratitude for social connectedness. Conclusions The TOCO program achieved initial success and promotes the social wellbeing of nursing home residents. We hope to continue this program beyond the COVID-19 pandemic in order to address this persistent need in a notably vulnerable patient population.

Objectives To estimate prescribing tends of and correlates independently associated with high‐risk anticholinergic prescriptions in adults aged 65 and older in office‐based outpatient visits. Design Repeated cross‐sectional analysis. Setting National Ambulatory Medical Care Survey (NAMCS). Participants A national sample of office‐based physician visits by adults aged 65 and older from 2006 to 2015 (n=96,996 unweighted). Measurements Prescriptions of high‐risk anticholinergics, regardless of indication, were identified, and overall prescribing trends were estimated from 2006 to 2015. Stratified analyses of prescribing trends according to physician specialty and anticholinergic drug class were also performed. We used a multivariable logistic regression analysis to estimate the odds of high‐risk anticholinergic prescription. Results Between 2006 and 2015, a high‐risk anticholinergic prescription was listed for 5,876 (6.2%) 96,996 visits of older adults, representative of 14.6 million total visits nationally. The most common drug classes were antidepressants, antimuscarinics, and antihistamines, which accounted for more than 70% of prescribed anticholinergics. Correlates independently associated with greater odds of receiving a high‐risk anticholinergic prescription were female sex, the Southern geographic region, specific physician specialties (e.g., psychiatry, urology), receipt of 6 or more concomitantly prescribed medications, and related clinical diagnoses (e.g., urinary continence) (p

This cross-sectional study evaluates the degree of anticoagulant use among nursing home residents with advanced dementia and atrial fibrillation at the end of life.

Background/Objectives Timely administration of antiischemic therapies improves outcomes in individuals with acute myocardial infarction (AMI). Prior literature on delays in AMI care has largely focused on in-hospital delay (“door to balloon” time). Our objective was to identify factors associated with prehospital delay in a contemporary national cohort of older adults with AMI. Design Cross-sectional analysis of data from the ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study, an observational study of older adults hospitalized for AMI. Setting U.S. academic and community hospitals (N = 94). Participants Individuals aged 75 and older hospitalized for AMI (N = 2,500). Measurements Prehospital delay was defined as symptom duration of 6 hours or longer before hospital presentation and was obtained according to participant or caregiver report during AMI hospitalization. Potential predictors of delay from demographic, clinical presentation, comorbid conditions, function, and social support domains were obtained through in-person assessment during the index hospitalization and medical record abstraction. Results Nonwhite race (adjusted odds ratio (aOR) = 1.54, P = .002), atypical symptoms (aOR = 1.41, P = .001), and heart failure (HF) (aOR = 1.35, P = .006 for HF) were significantly associated with delay. Conclusion In contrast with younger AMI populations, female sex and diabetes mellitus were not associated with delay in this older cohort, but factors from other domains (nonwhite race, atypical symptoms, and HF) were significantly associated with delay. These results can be used to customize future public health efforts to encourage early presentation for older adults with AMI.

The effective permittivity of low-density polyethylene with the conductive carbon black (CB) was modelled by COMSOL. The impact of CB content on the electric properties of the composites with different geometry of the inclusions was investigated. The modelling outcomes evidenced that the simulation was in good agreement with the experiment results at low-filler concentration. The effect of moisture on the effective permittivity of the composites was also investigated. A thin layer of adsorbed water on the surface of the CB particles was found to significantly increase the conductivity, which is in agreement with experimental results.

With the development of novel functions of nanomaterials (NMs), NMs-based coatings are today becoming smarter, stronger, and more durable. Coatings today do not only serve as the physical barrier or decoration but also act as the multifunctional and smart interface. In general, the barrier performance of organic coatings is enhanced by the incorporation of nanofillers by increasing the diffusion pathway deleterious species. Thus the coatings containing NMs (nanofillers) are expected to improve both barrier and mechanical properties. However, in practice the properties of nanocomposite coatings still do not match those of their expectation. Therefore further studies are needed to better understand the main mechanisms in which NMs interact with the substrate. In addition, the functionalization of NMs has led to advances in smart nanocomposite coatings, such as self-healing, antifouling, self-cleaning, antibacterial, and cooling coatings. On the other hand, superhard properties could be obtained for metallic coatings by producing the hard nanocrystalline phases within a metal matrix, such as TiN (or ZrN) in Ni matrix, ZrN (or CrN) in Cu matrix.

Objectives To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. Design Retrospective cohort study. Setting Academic hospital with ambulatory follow-up. Participants Community-dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). Measurements Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. Results Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in-hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in-hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in-hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. Conclusion Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.